HYPERBARIC-OXYGEN THERAPY IN THE PEDIATRIC-PATIENT - THE EXPERIENCE OF THE ISRAEL-NAVAL-MEDICAL-INSTITUTE

The pediatric patient is to be found in hyperbaric facilities througho ut the world, receiving hyperbaric oxygen (HBO) therapy for both life- threatening and chronic diseases. Objective. To review the experience accumulated at the Israel Naval Medical Institute in the treatment of pediatric patients. Design. A retrospective analysis and review of all records of patients younger than age 18 years. Results. Between 1980 and 1997, 139 pediatric patients age 2 months to 18 years (mean, 7.7 y ears) received HBO treatment at the Israel Naval Medical Institute. Of the children, 111 (79%) suffered from acute carbon monoxide (CO) pois oning 13 (9.2%) were treated after crush injury, traumatic ischemia, o r compartment syndrome; 4 (2.8%) had clostridial myonecrosis; 1 (0.7%) had necrotizing fasciitis; 5 (3.6%) had refractory osteomyelitis; 2 ( 1.4%) had suffered massive air embolism; 2 (1.4%) had purpura fulminan s; and 1 (0.7%) suffered from decompression sickness. Outcome, judged by neurologic sequelae, mortality, and extent of soft tissue loss and limb amputation, was favorable in 129 patients (93%). Two patients (1. 4%) died, 1 as a result of CO poisoning and the other, gas gangrene; 2 of the patients in the CO group (1.4%) remained with neurologic seque lae, and 6 patients in the acute traumatic ischemia group (4.3%) under went limb amputation. Conclusions. We had a favorable experience with 129 of a total 139 pediatric patients treated at our facility for the indications listed. A basic knowledge of HBO therapy is needed to refe r the pediatric patient for treatment when indicated. The needs of the pediatric patient, especially the critically ill, require specific sk ills and equipment inside the hyperbaric chamber. Close collaboration between the pediatrician and the hyperbaric medicine physician is esse ntial to ensure adequate care for infants and children.